Steerable suture retriever

ABSTRACT

A positioning and retrieval device manipulated by carrying element coupled to an handle and driven by an actuator that allows for axial movement and rotational movement of a capturing portion on the carrying element.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application is a non-provisional of U.S. Provisional application62/849,568 filed on May 17, 2019, the entirety of which is incorporatedby reference.

BACKGROUND OF THE INVENTION

Suturing techniques and instruments facilitate the suturing of tissueduring endoscopic and open surgical procedures. The term “endoscopic”encompasses arthroscopy, laparoscopy, hysteroscopy, etc., and endoscopicsurgery involves surgical procedures that are performed on a patient'sthrough small openings as opposed to conventional open surgery throughlarge incisions. The access to a surgical site in an endoscopicprocedure relies on one or more portals created in the patient's body orthrough one or more cannulas inserted into the patient's body throughsmall incisions. The use of sutures in endoscopic procedures relies onremote retrieval of the suture when it is passed through, tied to,and/or anchored in tissue of the surgical site.

Various instruments and techniques exist and are used for surgicalrepairs requiring the passing of sutures back through tissue. Forexample, a suture snare is used with suture passers to retrieve thesuture within the joint space during endoscopic surgery. Due to thelimited space within the joint, deployment of the snare is oftenchallenging. There remains a need for a minimally invasive surgicalinstrument that can retrieve or pass a suture or similar surgical item,where the device can allow for steerability as well ease of manipulationto grasp or release a suture used in a surgical procedure.

BRIEF SUMMARY OF THE INVENTION

The illustrations and variations described herein are meant to provideexamples of the methods and devices of the invention. It is contemplatedthat combinations of aspects of specific embodiments or combinations ofthe specific embodiments themselves are within the scope of thisdisclosure.

The present disclosure includes a surgical instrument for manipulating acomponent within a patient. The devices and methods described herein canmanipulate by positioning or retrieving the component. Such componentsinclude, but are not limited to, sutures, anchors, clips, staples, orany surgical component used in a medical procedure. The devices andmethod described herein can be used in any open surgical procedure orany procedure performed via arthroscopic, endoscopic, thorascopic orsimilar means.

In one example, an instrument according to the present disclosureincludes a shaft having a far portion, a near portion, and an arcuateshaft segment located between the far portion and the near portion suchthat a far end of the shaft extends radially away from an axis of thenear portion; a lumen extending through the shaft and exiting at the farportion; a handle fixed relative to the near portion of the shaft, suchthat rotation of the handle causes rotation of the shaft; a suturecarrying element comprising a main segment, a capture portion at adistal end, and an arcuate element segment proximal between the captureportion and the main segment, such that in an unconstrainedconfiguration the capturing portion extends radially away from an axisof the main segment, the suture carrying element being elasticallydeformable into a constrained configuration when located within thelumen; and an actuator housed in the handle and coupled to the mainsegment of the suture carrying element, the actuator being moveablerelative to an axis of the handle simultaneously in a rotationaldirection and in an axial direction, such that the suture carryingelement can be simultaneously rotated and advanced relative to the shaftusing the actuator.

In one variation of the surgical instrument of claim 1, the arcuatesegment is configured such that when moved with the opening at the farportion the arcuate segment deflects to cause the capturing portion tomove through an arc such that rotation of the suture carrying elementcan reposition the capturing portion within an increased distancewithout moving the far portion of the shaft. The arcuate segment canalso be configured to cause the capturing portion to re-enter theopening at the far portion in a single position relative to the opening.

In another variation, the actuator is positioned within the handle andis moveable relative to the axis of the handle simultaneously in therotational direction and in the axial direction while the handle remainsstationary.

A variation of the instrument can further include a torque shaftextending in the lumen and coupling the main segment to the actuator,wherein a torsional stiffness of the torque shaft is greater than atorsional stiffness of the main segment such that the torque shafttransfers rotation to the main segment.

In one variation the torque shaft comprises a stainless steel hypodermictubing. Alternatively, or in combination, the torque shaft can comprisea reinforcement member coupled to a portion of the main segment to forma reinforced segment, such a torsional stiffness of the reinforcedsegment is greater than a torsional stiffness of a remainder of the mainsegment such that the torque shaft transfers rotation to the remainderof the main segment.

Variations of the device includes a capturing portion that extends in au-shaped profile having a first leg and a second leg with an openingtherebetween, the first leg being continuous with the arcuate elementsegment.

In an additional variation, an arc of the arcuate element segment isgreater than 90 degrees such an apex of the arcuate element segment ispositioned distally of the first leg, such that when a suture is locatedagainst the apex, distal movement of the suture capturing element urgesthe suture into the u-shaped profile.

Variations of the surgical instrument include a shaft that is rigid ormalleable. Alternate variations include a rigid shaft with a malleablesection.

Variations of the instrument include a capture portion that comprises au-shape having a first leg connected to the arcuate element segment, asecond leg having a free end and a u-segment between the first leg andthe second leg, where the u-segment forms a seat for the suture. Inadditional variations, the capture portion is angled 45 degrees relativeto an axis of the main segment.

Surgical instrument of the present disclosure can optionally include asharp tip located at the distal end which allows the distal end of therigid shaft to penetrate through soft tissue when advanced therethrough.

In variations of the device, the handle of the instrument furthercomprises a window opening and where the actuator is accessible throughthe window opening. In certain variations, the actuator is recessedwithin the window opening.

The suture carrying element can comprise a superelastic alloy. Thecapture portion can include an opening disposed proximal to the distalend including a distal concave surface facing proximally for retainingthe suture within the opening as the instrument is drawn proximally. Insome variations, the capture portion comprises a pivotably operable jaw.Alternatively, the capture portion comprises a v-shape having an apexand an open end, where the apex is distal to the open end.

The present disclosure also includes methods for manipulating a suturepassed through a tissue region. For example, one such method includespositioning a shaft adjacent to the tissue region using a handle, wherethe shaft is affixed to the handle such that rotation and axial movementof the handle produces rotation and axial movement of the shaft, theshaft having an arcuate segment proximate to a sharp distal tip; passinga distal opening of the shaft through the tissue region and advancingthe shaft through the tissue region using the handle; manipulating anactuator in the handle to advance a suture carrying element through alumen of the shaft, where the suture carrying element a main segment, acapture portion at a distal end, and an arcuate element segment proximalbetween the capture portion and the main segment, such that in anunconstrained configuration the capturing portion extends radially awayfrom an axis of the main segment, the suture carrying element beingelastically deformable into a constrained configuration when locatedwithin the lumen; simultaneously rotating the handle while rotating andaxially moving the actuator to engage the suture with the capturingportion; proximally moving the actuator relative to the handle toretract the capturing portion and the suture within the shaft; andretrieving the shaft through the tissue region to pull the suturethrough the tissue region.

In one variation of the method, proximally moving the actuator relativeto the handle to retract the capturing portion and the suture within theshaft causes the arcuate element segment to deform when withdrawn intothe distal opening of the shaft causing the capturing portion to movetowards an axis of the distal end of the shaft without deforming thecapturing portion.

The present disclosure also includes a medical device comprising: ahandle portion having a cylindrical bore; an actuator having acylindrical periphery that forms a slidable fit with the cylindricalbore; a shaft fixed relative to the handle portion; a torque shaft fixedto the actuator, where rotation and/or axial movement of the actuatorcauses rotational and/or axial movement of the torque shaft; a fixedcomponent secured to a distal end of the shaft; and an actuatablecomponent coupled to both the fixed component and the torque shaft,where movement of the actuator causes movement of the actuatablecomponent relative to the fixed component.

DESCRIPTION OF THE DRAWINGS

Each of the following figures diagrammatically illustrates aspects ofthe invention. Variation of the invention from the aspects shown in thefigures is contemplated.

FIG. 1A illustrates a variation of a surgical instrument formanipulating or retrieving an item such as a suture.

FIG. 1B illustrates a magnified view of the section 1B from FIG. 1A.

FIG. 2A illustrates another magnified view of a shaft of an instrumentto better illustrate movement of a carrying element within a lumen ofthe shaft.

FIGS. 2B and 2C illustrate a device with a torque shaft or reinforcedcarrying element.

FIGS. 3A to 3H illustrate examples of carrying elements extendingdistally from a lumen or opening in a distal of a shaft of an instrumentas described herein.

FIG. 4 provides an illustrated example of positioning a shaft of aninstrument through tissue.

FIGS. 5A to 5F illustrate an example of manipulating a variation of asurgical instrument of the present disclosure to secure a suture 20.

FIGS. 6A to 6D illustrate some additional variations of carryingelements with various types of capturing portions at an end of theshaft.

FIGS. 7A and 7B show alternative shaft configurations of variations ofthe instrument described herein.

FIG. 8 illustrates a cross sectional view of a handle with a cylindricalactuator floating within the actuator.

DETAILED DESCRIPTION

It is understood that the examples below discuss uses in minimallyinvasive arthroscopic procedures. However, unless specifically noted,variations of the device and method are not limited to use inarthroscopic procedures. Instead, the invention may have applicabilityin various parts of the body under any minimally invasive or invasiveprocedure. Moreover, the invention may be used in any procedure wherethe benefits of the method and/or device are desired.

FIG. 1A illustrates a variation of a surgical instrument 100 formanipulating an item (not shown in FIG. 1A) during a medical procedure.For the sake of illustration, the item being manipulated is depicted asa suture and one variation of the surgical instrument comprises a sutureretriever/manipulator. However, variations of the surgical instrumentare not limited to sutures. For example, the instrument can be used tomanipulate or retrieve implants, fabric (such as gauze or sheets),threads, wires, etc. As shown in FIG. 1A, a variation of the instrument100 includes a shaft 102 coupled to a handle 120. The shaft 120 caninclude a near portion 104 (e.g., a section of the shaft 102 that isadjacent the handle 120) and a far portion 106 (e.g., a section of theshaft 102 that is towards a distal end 108 of the shaft 102). In theillustrated variation of the instrument 100, the far portion 106includes an arcuate or angled segment 114 that causes a far end 112 ofthe shaft 102 to extend at an angle or radially away from an axis 116 ofthe shaft 102. Variations of devices described herein can include shafts102 with angled segments 114 that produce an angle greater than 0degrees to 90 degrees. However, the disclosure includes any angle aswell as straight shafts. Moreover, in alternate variations the angledsegment 114 can also be located at the near portion 104 of the shaft102.

The medical apparatus 100 illustrated in FIG. 1A also shows a nearportion 104 separated from a far portion 106 by a tapered transitionsection 110, alternative variations of the device do not require thedifferent sections of the shaft 102 to be different diameters ordifferent configurations. However, varying diameters of the shaft 102can provide benefits depending upon the main intended procedure of thedevice. For example, in the variation illustrated in FIG. 1A, a shaft102 with a larger diameter at the near portion 104 provided forincreased column strength when manipulating the instrument 100 via thehandle 120. The smaller diameter far portion 106 of the shaft 102reduces a force required to advance through tissue. In alternatevariations, a device 100 according to the present disclosure includesvarious portions (e.g., 104, 106) having different cross-sectionalprofiles than the circular profiles shown.

FIG. 1B illustrates a magnified view of the section 1B from FIG. 1A.FIG. 1B shows a lumen 108 that extends through the shaft 102, exiting atthe far end 112. Variations of the device 102 can include a shaft lumen102 that extends into the handle 120. In alternate variations of thedevice, the lumen can exit from other portions of the shaft not just thefar end 112. Moreover, alternate variations of the device 100 includeone or more lumens that exit through multiple portions of the deviceand/or shaft. In any case, the shaft 102 can include a main lumen 108that accommodates a carrying element 140, which as described below, canbe advanced, retracted, and/or rotated using controls coupled to thehandle 120. The carrying element 140 is referred to herein as a suturecarrying element 140, however, the carrying element 140 can be used tomanipulate and/or retrieve a number of surgical items as describedabove. FIG. 1B also illustrates the far end 112 as having a sharp tipthat can penetrate tissue. Alternate variations of the instrument 100 donot require a sharp tip. Instead, the tip can be rounded or blunted todissect tissue.

FIG. 1B also illustrates a variation of a capture portion 144 beingconfigured in a U-shape with a first leg 156 adjacent to the arcuatesegment 152 of the carrying element 140 and a second leg 158 being opento permit positioning of a suture (or other component) adjacent to aseat 155 of the capturing portion. As noted herein, and shown below, thedevices described herein can include capturing portions of variousshapes as well as actuatable arms or graspers.

FIG. 1A also shows a handle 120 located adjacent to the near section 104of the shaft 102. Variations of the instrument 100 include handles 120that are affixed to or relative to the shaft 102 such that rotation ofthe handle 120 causes rotation of the shaft 102. The handle 120 alsoincludes an actuator 130 that is coupled to the carrying element 140 andallows for movement of the carrying element 140 relative to the shaft102. In the illustrated variation, as also discussed below, the actuator120 can allow for rotational and/or axial movement of the carryingelement 140 relative to the shaft. In this variation of the instrument100, the handle 120 includes a body 120 with a window 124 that exposesthe actuator 130. This configuration allows for rotation of the handle120 without any features of the actuator 130 that protrude from thehandle body 122. In alternate variations, a portion of the actuator 130can protrude from the handle body 122. The actuator 130 can includefeatures, such as the recessed pockets 132, that ease positioning of anoperators fingers while the operator's hand is able to grasp the remainportion of the handle body 122. This allows control of the handle 120and simultaneous adjustment of the actuator 130 using a single hand.Although not illustrated, the recessed features 132 of the actuator canextend around a circumference of the actuator 130.

FIG. 1A further shows an optional feature of the handle 120 where aproximal opening 126 for a lumen that is in fluid communication with theshaft lumen 108. This allows for flushing of the shaft 102 oradvancement of a suture through the device.

FIG. 2A illustrates another magnified view of a shaft 102 of aninstrument to better illustrate movement of the carrying element 140within the lumen 108 of the shaft 102. The capturing element 142 cancomprise a main segment 142 that is elastically deformable such that itcan navigate any bend or arcuate segment 114 of the shaft 102 withoutretaining the deformation. In certain variations, the main segment 142and/or entire capturing element 140 is fabricated from a super elasticalloy or a flexible material (e.g., alloy, polymer, or similarmaterial). The carrying element 140 is coupled to the actuator (notshown) along a portion of a proximal end of the main segment 142,wherein rotation of the actuator causes the capturing element 140 torotate. Furthermore, axial movement of the actuator (or other component)along an axis of the handle (not shown) will cause axial movement 146 ofthe capturing element 140 about an axis 148 of the main segment 142.Rotation of the actuator also causes the capturing element 140 to rotateabout the axis 148 causing a capture portion 144 to rotate in a patternup to a 360 degree pattern 150.

FIG. 2B illustrates an actuator 130 coupled to a carrying element 140via a torque shaft 180. The torque shaft 180 provides a connectionbetween the carrying element 140 and actuator 130 but also provides atorsional strength or stiffness that allows the actuator 130 to transfera consistent rotation to the carrying element 140 in addition toproviding an axial translation (in those variations requiring bothrotation and axial movement). In those previous devices without a torqueshaft the wire used to secure the suture twists and binds ifover-rotated. The torque shaft 180 of the present disclosure can extendthe distance of the shaft 102 with the carrying element 140 connected toa distal end of the torque shaft 180. The torque shaft 180 can alsoprovide provides rigidity and linear structure to the device. Inalternate variations, a carrying element 140 can be directly coupled tothe actuator 130 but forms a torque shaft 180 using a reinforcementmember (e.g., sheath, coating, tube, etc.) over a portion of the mainsegment 142 of the carrying element 140. In such a case, similar to thetorque shaft, the reinforcement allows the actuator 130 to transferrotation to the capture portion 144 while minimizing binding andtorque/torsion loading of the capture portion 144.

FIG. 2C illustrates a magnified view of a variation of a carryingelement 140 and torsion shaft 180. As illustrated, the torsion shaft 180can comprise a hypotube (e.g., stainless steel) that includes a passage180, where the main segment 142 is loaded within the passage 180 at adistal end of the torsion shaft 180. Variations of the device caninclude a torsion shaft 180 (or reinforcement) that does not enter thearticulated segment 114 of the shaft. Alternatively, the torsion shaft180 (or reinforcement) can extend at least partially into or beyond thearticulated segment 114.

FIGS. 3A to 3H illustrate an example of a carrying element 140 extendingdistally from a lumen or opening 108 in a distal end 112 of a shaft 102of an instrument as described herein. As noted above, a main segment 142of the carrying element 140 can be axially advanced in a direction 146relative to the shaft 102. In variations of the device 100, the carryingelement 140 can be positioned entirely within the shaft 102 and advanceddistally from the opening 108 as needed. The carrying element 140includes a capturing portion 144 that is typically at a distal end. Inthe illustrated variation shown in FIG. 3A, the capturing portion 144extends away from an axis 148 of the main segment 142. As discussedbelow, providing the capturing portion 144 at a distance from the axis148 of the main segment increases the ability of an operator toreposition the carrying element 140 and capture section 144 through arange of positions adjacent to the distal end 112 of the shaft 102. Inthe illustrated variation of FIG. 3A, the capturing portion 144 ispositioned approximately 90 degrees from the axis 148 of the mainsegment 142. However, variations of devices can include a capturingelement with an angular spacing that ranges between 0 and 180 degreesrelative to the axis 148 to extend in a radial direction from the axis148 of the main segment. For convenience, the angle can be measured fromeither leg of the capture portion 144. In order to position the captureportion 144 at an angle to the main segment axis 148, the carryingelement 140 can include one or more arcuate sections/segments 152between the capturing portion 144 and the main segment 142.

FIG. 3B illustrates a configuration where the carrying element 144 hasbeen withdrawn proximally towards the shaft 102 such that the mainsegment (not pictured) is within the shaft 102 and the arcuate segment152 engages a side of the distal end 112. Continued withdrawal of thecarrying element 140 in the proximal direction 146 will cause thecapturing portion 144 to move in an arc 154 and into alignment with thelumen 108 of the shaft 102. Movement of the capturing portion 144 in anarc pattern 154 is desirable to prevent the suture (or other item beingcarried) from engaging a side of the wall of the distal end 112. Thisarc pattern 154 movement is primarily made possible by the largeradiused arcuate segment 152.

FIGS. 3C and 3D illustrate additional variations of the capturingelement 140 to illustrate the features of an arc angle of the arcuatesegment 152 of the capturing element 140. The arc angle can be measuredstarting from the location where the arcuate segment 152 deviates froman axis of the main segment 142 to location where the arcuate segment152 becomes parallel to or meets a leg of the capturing portion 144. InFIG. 3C, the sweep angle 160 of the arcuate segment 152 is approximately90 degrees. In FIG. 3D, the arc angle 160 is greater than 90 degrees. Itis believed that an arc angle greater than 90 degrees coupled with alarge radius arc segment 152 improves the ability of the device toretrieve a suture or similar structure within an opening of the shaft.The combination of arc angle and large radius arc segment (coupled withthe repositioning of the shaft) provides an increased range for anoperator to maneuver the carrying element from the location where itpasses through tissue to a location where a suture (or other medicalitem) is located.

FIG. 3E illustrates a variation of the carrying element 140 thatincludes an arc angle greater than 90 degrees where the carrying element140 is retracted in a proximal direction 146 to within the shaft 102. Asshown, the capturing portion 144 continues to move in an arc 154(relative to FIG. 3B) as the arcuate segment 152 engages a wall of thedistal end 112 when withdrawn into the shaft 102. FIG. 3F illustrates astate of the instrument when the arcuate segment 152 is within the shaft102. As shown, because the arc angle is greater than 90 degrees, thecapture portion 144 can enter the shaft in alignment with theopening/lumen 108. FIG. 3G shows the carrying element 140 as it retractsinto the shaft until the carrying element 140 and capture portion 144are fully within the shaft 102. As shown, retracting the carryingelement 140 causes the arcuate element segment 152 to deform against thedistal end such that the capturing portion 144 sweeps to move towardsalignment with an axis of the opening 108 (as shown in FIGS. 3F and 3G)without deforming during movement outside of the shaft 102. In certainvariations, the capturing portion 144 (either entirely or a portionthereof) can deform as it enters the shaft lumen 108, which compressesthe suture (or component). This configuration allows for a suture to beretained within or against the capturing portion 144 as it isrepositioned outside of the shaft and prepared for withdrawal into theshaft.

It should be noted that variations of the instruments described hereininclude the ability to retract the carrying element 140 (as shown inFIGS. 3A to 3B and 3D to 3H) while simultaneously rotating (asdemonstrated in FIG. 2A).

The ability to move axially while simultaneously rotating allows forincreased positioning of the capturing portion 144 during positioning ofthe carrying element 140 when trying to secure the suture (or othermedical component) as well as allows for the capture portion 144 to berotated when a suture (or other medical component) is secured therein.In the latter case, rotation of a suture (or other element) securedwithin the capture portion 144 can cause the suture to wrap about thecarrying element 140, which further assists in manipulation of thesuture.

Another feature of the present device is that the distal end 112 of theshaft 102 comprises a tapered or beveled end at the opening 108. In suchvariations, the tapered opening 108 as well as the shape and angle ofthe arcuate segment 108 of the carrying element 140 allows the captureportion 144 to slightly deform such that it enters the opening 108 in aconsistent manner regardless of the position of the carrying captureportion 144 when extended. As noted above, variations of the device relyon a torque shaft that is connected to the actuator. Therefore, therelatively short length of the capture portion 144 and main segment thatis not reinforced allows the main segment to flex as it re-enters theshaft 108.

In variations of the device, the arcuate segment provides an advantagein being configured such that when moved with the opening at the farportion the arcuate segment 152 deflects to cause movement of thecapturing portion 144 through an arc 154. This allows the capturingportion to move through a range of positions such that rotation of thesuture carrying element can reposition the capturing portion within anincreased distance to reach a suture without having to move the farportion of the shaft. Another benefit is that in variations of thedevice, the arcuate segment is configured to cause the capturing portionto re-enter the opening at the far portion in a single position relativeto the opening. This means that regardless of the orientation of thecapturing portion 144 (e.g., if it is rotated 180 degrees from thatshown in FIG. 3E, the capturing portion will orient as shown in FIGS. 3Eand 3F when retracted within the shaft 102.

FIG. 4 provides an illustrated example of positioning a shaft 102 of aninstrument according to the present disclosure. For purposes ofillustration FIG. 4 shows a section of tissue 2 having a first surface 4and a second surface 6. The instruments described herein are especiallyuseful in applications where a suture 20 extends from a first surface 4to a second surface 6 through an opening 8 and must be withdrawn backthrough the tissue 2 from the second surface 6. In some cases, themedical practitioner only has visual access to the second surface 6while manipulating the instrument from the first surface 4. FIG. 4illustrates the suture 20 as having a loop configuration. However, otherconfigurations (e.g., a knot, hook, attached needle, etc.) areconsidered to be within the scope of this disclosure. Furthermore, theillustrated suture 20 is shown to be a ribbon type configuration.However, the present disclosure includes sutures (or other medicalcomponents) of multiple shapes, sizes, and cross sections.

FIG. 4 illustrates a situation where a medical practitioner advances theshaft 102 through an opening 10 in the tissue 2 where the shaft 102includes a distal end 112 with a sharp tip. However, alternatevariations of the device include blunted, atraumatic, or otherwiserounded ends. In the initial advancement of the shaft 102, the opening108 might be mis-aligned with the suture 20.

FIGS. 5A to 5F illustrate an example of manipulating a variation of asurgical instrument 100 of the present disclosure to secure a suture 20.As noted herein, the devices disclosed herein can position, retrieve, orotherwise manipulate a suture or other surgical component. FIG. 5Aillustrates a state immediately after the shaft 102 is advanced throughtissue 2. For purposes of illustration, the shaft 102 and handle 120 arenot drawn to scale.

As shown in FIG. 5A, once the shaft 102 of the device 100 is positionedthrough tissue 2, the handle 120 can be rotated in either direction 134to produce a corresponding rotation 134 of the shaft 102. In most cases,the medical practitioner will be able to manipulate the handle 120 whilevisually observing the distal end 112 of the shaft 102. In alternatevariations, the shaft 102 can be made sufficiently radiopaque (or haveradiopaque markers) such that it is observable under x-ray or a CT scan.Alternatively, the device can be made to be visible under alternatenon-invasive imaging (e.g., visible under ultrasound imaging, etc.).Regardless, the medical practitioner can position the far/distal end 112of the shaft 102 such that the opening/lumen 108 is placed sufficientlyclose to the suture 20. The arcuate segment 114 of the shaft 102 canfurther increase the ability to position the opening 108 of the shaft102 away from the tissue opening 10 by axial movement of the entireshaft 102 as well as rotation of the handle 120. Clearly, the device 100provides the medical practitioner with the ability to reposition thedistal end 112 using a single hand.

FIG. 5B illustrates a configuration where the carrying element 140advances in an axial direction 146 upon a corresponding axial movement146 of the actuator 130 coupled to the handle 120. As noted above, somevariations of the instrument 100 allow for simultaneous rotation 150 ofthe actuator, which produces corresponding rotation 150 of the carryingelement 140. In addition, the handle 120 can be rotated 134 and/oraxially moved 136 to produce corresponding rotation 134 and/or axialmovement 136 of the shaft 102. In those procedures where the instrument100 is used to retrieve a suture 120, the manipulation of the handle 120and actuator 130 are used to position the capturing element 144 adjacentto the suture 20.

FIG. 5C illustrates the carrying element 140 as being advanced into aloop of the suture 20. As noted above, in alternate variations thesuture 20 will include a knot, needle, hook, etc. that is used to engagethe capture portion 144. FIG. 5D shows the capture portion 144 of thecarrying element 140 advancing beyond the suture 20. As noted herein,the capturing portion 144 as well as the remaining portion of thecarrying element 140 can be fabricated to be elastically deformable toassist in navigating to and securing the suture 20.

FIG. 5E illustrates the situation where either the device 100 and/or thecarrying element 140 is withdrawn relative to the suture 20 to securethe suture 20 within the capturing portion 144. FIG. 5F shows furtherwithdrawal of the carrying element (not illustrated in FIG. 5F) into theopening 108 of the shaft 102 to partially draw the suture 20 within theshaft 10 such that retrieval of the device 100 causes the suture 20 tobe pulled through the shaft opening 10 and through the tissue 2.

Although not illustrated, a suture 20 can be initially advanced throughthe tissue 2 using an instrument (i.e., a placement instrument). In sucha situation, the suture can either extend outside of the placementinstrument or extend within a shaft of the placement instrument. Asecond device (i.e., a retrieval instrument) can be used to secure aportion of the suture thereto. This allows the retrieval instrument tobe withdrawn back through tissue. A benefit of this dual instrumentprocedure is that both devices can be manipulated using either hand ofthe medical practitioner.

FIGS. 6A to 6D illustrate some additional variations of carryingelements 140 with various types of capturing portions 144 at an end ofthe shaft 102. FIG. 6A illustrates a capture portion 144 that has av-shape where the open legs of the v-shape are proximal to an apex ofthe v-shape. FIG. 6B illustrates an actuatable capture portion 155having a jaw structure joined at a hinge 162. The jaw structure can beoperated using one or more pull wires 164 that extends to a proximal endof the device and/or to a handle of the device. FIGS. 6C and 6Dillustrate a carrying element 150 having a capturing portion configuredin a coil structure 166. In such a case, the coil 166 can be flexiblesuch that a suture becomes secured within the turns of the coil 166.Although not illustrated, the turns of the coil 166 can be in contact orcan be separated by a gap.

FIGS. 7A and 7B illustrate additional variations of devices 100 asdescribed herein. For example, FIG. 7A illustrates an actuator 130within a handle 120, where the handle 120 is coupled to a shaft 102where the far portion 106 of the shaft 102 is straight. FIG. 6Billustrates a shaft 102 coupled to a handle 120 where the near portion104 and far portion 106 of the shaft are the same or similar diameters(e.g., the shaft 102 can comprise a single tubular member).

FIG. 8 illustrates another aspect of variations of devices 100 under thepresent disclosure. As shown, another feature of the device 100 is thatthe handle body 120 comprises a bore 128 that accommodates afree-floating sliding fit with an actuator 130. Although the actuator130 is shown to be a substantially solid cylindrical piece, it cancomprise any structure that has an effective cylindrical profile such asa varying surface comprising peaks and grooves where the peakseffectively form a cylindrical circumference that forms a sliding fitwith the bore 128 of the handle 120. Moreover, variations of the device100 include a body 120 that is non-cylindrical on an outer surface butcomprises a bore 128 that is sized to allow a sliding fit with theactuator 130. In the illustrated variation, the body 120 comprises acylindrical surface, which allows for a medical practitioner to graspthe body 100 with a palm of their hand and use their fingers to aid inmanipulation of the body 100 while the thumb can be used to provideaxial movement 146 of the actuator and/or rotational movement 150 of theactuator to drive a torque shaft 180 relative to a shaft 102 that isaffixed to the body 120. Such a handle configuration can be used for thecarrying element 140 as described herein. Moreover, this handleconfiguration can be used in a number of other medical devices used inarthroscopic, thorascopic, and/or endoscopic procedures.

FIG. 8 also shows the device 100 as having a tensioning component 170having a tensioning surface 172 that can adjust a force required to movethe actuator 130 within the bore 128. For example, the tensioningcomponent 170 and surface 172 can comprise a spring loaded ball-bearingthat applies an adjustable force on a portion of the handle 130.

As for other details of the present invention, materials andmanufacturing techniques may be employed as within the level of thosewith skill in the relevant art. The same may hold true with respect tomethod-based aspects of the invention in terms of additional acts thatare commonly or logically employed. In addition, though the inventionhas been described in reference to several examples, optionallyincorporating various features, the invention is not to be limited tothat which is described or indicated as contemplated with respect toeach variation of the invention.

Various changes may be made to the invention described. For example, theinvention includes combinations of aspects of the variations of thedevices described herein as well as the combination of the variationsthemselves. Also, any optional feature of the inventive variations maybe set forth and claimed independently, or in combination with any oneor more of the features described herein. Accordingly, the inventioncontemplates combinations of various aspects of the embodiments orcombinations of the embodiments themselves, where possible. Reference toa singular item, includes the possibility that there are plural of thesame items present. More specifically, as used herein and in theappended claims, the singular forms “a,” “and,” “said,” and “the”include plural references unless the context clearly dictates otherwise.

It is important to note that where possible, aspects of the variousdescribed embodiments, or the embodiments themselves can be combined.Where such combinations are intended to be within the scope of thisdisclosure.

We claim:
 1. A surgical instrument for manipulating a suture within apatient, the instrument comprising: a shaft having a far portion, a nearportion, and an arcuate shaft segment located between the far portionand the near portion such that a far end of the shaft extends radiallyaway from an axis of the near portion; a lumen extending through theshaft and exiting at the far portion at an opening; a handle fixedrelative to the near portion of the shaft, such that rotation of thehandle causes rotation of the shaft; a suture carrying elementcomprising a main segment having an arcuate element segment and acapture portion at a distal end, the capture portion having a first legextending from the arcuate element segment, a seat connecting the firstleg to a second leg that extends back towards the arcuate elementsegment and having a free end opposite from the seat, an opening betweenthe first leg and the second leg that faces towards an arc of thearcuate element segment, the opening configured to receive the suture;wherein in an unconstrained configuration the arcuate element segmentcauses the capture portion to extend radially away from an axis of themain segment, the suture carrying element being elastically deformableinto a constrained configuration when located within the lumen, andaxial movement of the arcuate element segment within the opening causesdeformation of the arcuate element segment to produce movement of thecapture portion in an arc profile independently of the shaft and withoutchanging a shape of the capture portion during movement through the arcprofile and during movement into the opening; and an actuator housed inthe handle and coupled to the main segment of the suture carryingelement, the actuator being moveable relative to an axis of the handlesimultaneously in a rotational direction and in an axial direction, suchthat the suture carrying element can rotate and advance eitherindependently or simultaneously relative to the shaft with movement ofthe actuator.
 2. The surgical instrument of claim 1, wherein the arcuateelement segment comprises an arc angle greater than ninety degrees. 3.The surgical instrument of claim 2, wherein the arcuate element segmentis configured to cause the capture portion to re-enter the opening atthe far portion in a single position relative to the opening.
 4. Thesurgical instrument of claim 1, wherein the actuator is positionedwithin the handle and is moveable relative to the axis of the handlesimultaneously in the rotational direction and in the axial directionwhile the handle remains stationary.
 5. The surgical instrument of claim1, further comprising a torque shaft extending in the lumen and couplingthe main segment to the actuator, wherein a torsional stiffness of thetorque shaft is greater than a torsional stiffness of the main segmentsuch that the torque shaft transfers rotation to the main segment. 6.The surgical instrument of claim 5, wherein the torque shaft comprises astainless steel hypodermic tubing.
 7. The surgical instrument of claim5, where an arc of the arcuate element segment is greater than ninetydegrees such an apex of the arcuate element segment is positioneddistally of the first leg, such that when a suture is located againstthe apex, distal movement of the suture capturing element urges thesuture into the u-shaped profile.
 8. The surgical instrument of claim 1,further comprising a reinforcement member coupled to a portion of themain segment to form a reinforced segment, such a torsional stiffness ofthe reinforced segment is greater than a torsional stiffness of aremainder of the main segment such that the torque shaft transfersrotation to the remainder of the main segment.
 9. The surgicalinstrument of claim 1, wherein the capturing portion forms a u-shapedprofile.
 10. The surgical instrument of claim 1, where the shaft isrigid.
 11. The surgical instrument of claim 1, where the shaft ismalleable.
 12. The surgical instrument of claim 1, where the captureportion is angled forty five degrees relative to an axis of the mainsegment.
 13. The surgical instrument of claim 1, further comprising asharp tip located at the far end which allows the far end of the shaftto penetrate through soft tissue when advanced therethrough.
 14. Thesurgical instrument of claim 1, where the handle further comprises awindow opening and where the actuator is accessible through the windowopening.
 15. The surgical instrument of claim 14, where the actuator isrecessed within the window opening.
 16. The surgical instrument of claim1, where the suture carrying element comprises a superelastic alloy. 17.The surgical instrument of claim 1, wherein the capture portioncomprises an opening disposed proximal to the distal end including adistal concave surface facing proximally for retaining the suture withinthe opening as the instrument is drawn proximally.
 18. The surgicalinstrument of claim 1, wherein the capture portion comprises a v-shapewherein the seat is formed by an apex of the v-shape, where the apex isdistal to the open end.
 19. A method for manipulating a suture passedthrough a tissue region, the method comprising: positioning a shaftadjacent to the tissue region using a handle, where the shaft is affixedto the handle such that rotation and axial movement of the handleproduces rotation and axial movement of the shaft, the shaft having anarcuate segment proximate to a sharp distal tip; passing a distalopening of the shaft through the tissue region and advancing the shaftthrough the tissue region using the handle; manipulating an actuator inthe handle to advance a suture carrying element through a lumen of theshaft, where the suture carrying element comprising a main segmenthaving an arcuate element segment and a capture portion at a distal end,the capture portion having a first leg extending from the arcuateelement segment, a seat connecting the first leg to a second leg andhaving a suture opening between the first leg and the second leg, suchthat in an unconstrained configuration the capturing portion extendsradially away from an axis of the main segment, the suture carryingelement being elastically deformable into a constrained configurationwhen located within the lumen; simultaneously rotating the handle whilerotating and axially moving the actuator to engage the suture within thesuture opening of the capturing portion remotely from the shaft andwithout deforming the capture portion; proximally moving the actuatorrelative to the handle to retract the capturing portion and suturetowards the shaft, where movement of the arcuate element segment in thedistal opening deforms the arcuate element segment to allow thecapturing portion to move in an arc profile without deforming whilemoving into the distal opening; retracting the capturing portion and thesuture within the shaft; and retrieving the shaft through the tissueregion to pull the suture through the tissue region.
 20. The method ofclaim 19, where the arcuate element segment comprises an arc anglegreater than ninety degrees, such that such an apex of the arcuateelement segment is positioned distally of the first leg, the methodfurther comprising distally advancing the apex against the suture tourge the suture into the u-shape of the capture portion.